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Two stakeholders applauding the state’s new proposal to better coordinate care for some of Ohio’s
sickest patients were skeptics not so long ago.

When the administration of Gov. John Kasich made public in January its intention to change how
health care is delivered to people eligible for both Medicare and Medicaid, the Ohio Association of
Area Agencies on Aging went public with its concerns. At one point, it enlisted the help of Ohio’s
Democratic congressional delegation to petition Kasich to make sure the area agencies remained a
part of long-term-care management for Medicaid patients.

Another group, AARP Ohio, was frank with Kasich’s aides in private meetings about what a plan to
coordinate care for Ohio’s “dual eligibles” should look like.

When the state formally delivered its proposal to the federal Centers for Medicare and Medicaid
Services on Monday, included in the administration’s public announcement were statements of support
from both the AARP and the area agencies on aging.

What persuaded them to endorse the plan?

“To their credit, they really did listen to what was being expressed all along,” Jane Taylor,
state director of AARP Ohio, said of the administration. “With all of the input from all the
groups, (the proposal) developed into something we could support.”

The area agencies on aging and the AARP shared the concern that under the state’s plan, Ohio’s
12 area agencies on aging might lose their administrative roles in the popular PASSPORT home-care
program.

But in Kasich’s formal proposal to the feds, including a three-year pilot program affecting
about 115,000 of the 182,000 Ohioans considered dual eligibles, managed-care companies are required
to contract with the area agencies for long-term-care management.

“I heard concerns from the triple-A’s six months ago,” said Republican state Rep. Cheryl
Grossman of Grove City, who helped arrange meetings with stakeholders and administration officials
to address concerns.

“People were listened to. Their points were made, and we’re very fortunate the two (Kasich
administration) directors involved helped to work out solutions together. I’m very pleased with
where we are.”

The two directors — Medicaid Director John McCarthy and Office of Health Transformation Director
Greg Moody — argue that the state’s all-encompassing proposal was more a result of a months-long
process than a single change.

McCarthy said from the release of the administration’s “concepts paper” in January, to its rough
draft proposal in February, it held dozens of public and private meetings with stakeholders to
craft a policy that fit their needs.

He said items such as allowing nursing-home residents to stay put, installing a transition
period of at least 365 days for patients to continue receiving care from current providers, and for
managed-care companies to pay Medicaid providers their current rates all were the results of those
meetings.

Even the nursing-home industry, which clashed with Kasich for much of 2011 and is opposed to
placing large amounts of responsibility with managed-care organizations, said it had a seat at the
table with the state’s plan.

“The administration worked with us to hear our concerns,” Van Runkle said. “Although there are
things we’ve talked about that are not readily apparent in the document, they’ve heard our concerns
and taken them into account to some degree.”